From the Guidelines
The diagnostic criteria for Hyperosmolar Hyperglycemic State (HHS) include plasma glucose >600 mg/dL, serum osmolality >320 mOsm/kg, profound dehydration, altered mental status, and minimal or absent ketosis, as stated in the most recent guidelines 1.
Key Diagnostic Criteria
- Plasma glucose >600 mg/dL (33.3 mmol/L)
- Serum osmolality >320 mOsm/kg
- Profound dehydration
- Altered mental status ranging from confusion to coma
- Minimal or absent ketosis
Calculation of Effective Serum Osmolality
The effective serum osmolality can be calculated using the formula: 2(Na+) + glucose/18 + BUN/2.8, as mentioned in previous studies 1.
Characterization of HHS
HHS is characterized by severe hyperglycemia without significant ketoacidosis, with arterial pH >7.30 and serum bicarbonate >20 mEq/L, as noted in the guidelines 1.
Clinical Presentation
Patients with HHS usually present with severe dehydration (water deficit of 100-200 mL/kg), hyperosmolality, and pre-renal azotemia with elevated BUN and creatinine, as described in the literature 1.
Mortality Rate
HHS carries a higher mortality rate (10-20%) than diabetic ketoacidosis, primarily affecting elderly patients with type 2 diabetes, as reported in the most recent study 1.
Treatment
Prompt recognition is essential, and treatment requires aggressive fluid resuscitation, insulin therapy, and correction of electrolyte abnormalities, as emphasized in the guidelines 1.
From the Research
Diagnostic Criteria for Hyperosmolar Hyperglycemic State (HHS)
The diagnostic criteria for HHS include:
- Plasma glucose level >600 mg/dL 2
- Increased effective plasma osmolality >320 mOsm/kg 2, 3, 4
- Absence of ketoacidosis 2, 3, 4
- Marked hypovolaemia 3
- Hyperglycaemia ≥30 mmol/L 3
- Osmolality ≥320 mOsm/kg using [(2×Na+) + glucose + urea] 3
- Without significant ketonaemia (≤3.0 mmol/L) 3
- Without significant acidosis (pH >7.3) and bicarbonate ≥15 mmol/L 3
Key Differentiators from Diabetic Ketoacidosis (DKA)
The key differentiators for HHS from DKA are:
- Serum osmolality greater than 320 mOsm/kg 4
- Lack of metabolic acidosis 4
- Minimal to no presence of ketones 4
Clinical Features
The clinical features of HHS include: